Clinical features

Angina is often a clinical diagnosis: (1)

• atypical presentation is frequently seen in women than in men, in older patients than in younger patients and in patients with diabetes
• angina is typically a tight, dull or heavy discomfort often seen retrosternally or left side of the chest
• the pain is usually not sharp or stabbing in character and is not influenced by respiration or relieved by antacids and simple analgesia
• there is usually some association with exertion or emotional stress; rest brings relief within a few minutes:
  • discomfort may radiate to arms, neck, jaw or back
• additional precipitants include:
  • cold weather
  • heavy meals
  • emotion
• nitrates typically offer rapid relief
• pain may be associated with atypical symptoms such as fatigue or faintness, nausea, burping, restlessness or a sense of impending doom These atypical symptoms are more likely to be seen in women, older patients and in diabetic patients (2)

The clinical examination is often normal in a patient complaining of angina. There may be signs of conditions which accelerate atherosclerosis:

• there may be signs of conditions which precipitate angina
  • anaemia - pallor
  • thyrotoxicosis - resting tachycardia, tremor, and goitre
• hypertension:
  • the blood pressure should be documented
  • displaced apex beat and fourth heart sound if there is left ventricular hypertrophy
• hypercholesterolaemia:
  • xanthelasma and xanthoma
• smoking:
  • nicotine stains
• diabetes:
  • retinopathy
  • neuropathy

Reference:

• 1. NICE. Stable angina: management. Clinical guideline [CG126]Published: 23 July 2011 Last updated: 25 August 2016
• 2. Von H. et al. Typical and Atypical Symptoms of Acute Coronary Syndrome: Time to Retire the Terms? Journal of the American Heart Association March 2020. Vol. 9, No. 7.